Abstract
Despite technical advancements and disease understanding, variceal bleeding remains
the leading cause of mortality in patients with cirrhosis. Endoscopic therapies are
the main cornerstone of therapy in variceal bleeding. Interventional radiology (IR)
plays a significant role in managing variceal bleeding, especially in cases where
endoscopic therapies are not feasible or failed. Cross-sectional imaging is often
critical to identify relevant anatomy before IR therapies. Transjugular intrahepatic
portosystemic shunt (TIPS) is indicated as salvage therapy in patients with refractory
variceal bleeding. Retrograde transvenous variceal embolization (RTO) procedures provide
superior bleeding control in patients with gastric and ectopic varices, however, without
increasing the risk of hepatic encephalopathy and liver function deterioration. Antegrade
transvenous obliteration is a viable alternative when RTO is not feasible. Left-sided
portal hypertension is a distinct entity resulting from splenic vein stenosis or occlusion,
and variceal bleeding in left-sided portal hypertension does not respond to TIPS,
requiring variceal embolization, partial splenic embolization, or splenic vein recanalization.
Occasionally, endovascular splenorenal or mesorenal shunt and splenic vein occlusion
with distal splenorenal diversion are performed to control variceal bleeding. This
article entails the basic concepts and procedural aspects of various interventional
radiological procedures performed in patients with variceal bleeding.
Keywords
variceal bleeding - gastric varices - TIPS - BRTO - interventional radiology
